scholarly journals Critical care at the end of life: a population-level cohort study of cost and outcomes

Critical Care ◽  
2017 ◽  
Vol 21 (1) ◽  
Author(s):  
Dipayan Chaudhuri ◽  
Peter Tanuseputro ◽  
Brent Herritt ◽  
Gianni D’Egidio ◽  
Mathieu Chalifoux ◽  
...  
Keyword(s):  
Critical Care ◽  
Cohort Study ◽  
End Of Life ◽  
Population Level

scholarly journals Deaths in critical care and hospice—prevalence, trends, influences: a national decedent cohort study

2021 ◽  
pp. bmjspcare-2021-003157
Author(s):  
Jonathan Mayes ◽  
Stela McLachlan ◽  
Emma Carduff ◽  
Joanne McPeake ◽  
Kirsty J Boyd ◽  
...  
Keyword(s):  
Critical Care ◽  
Cohort Study ◽  
End Of Life ◽  
Cause Of Death ◽  
Support Services ◽  
Multinomial Logistic Regression ◽  
Population Level ◽  
Critical Care Units ◽  
Location Of Death ◽  
Level Data

ObjectivesEnd-of-life and bereavement care support services differ in critical care and inpatient hospice settings. There are limited population-level data comparing deaths in these two locations. We aimed to compare the characteristics of people who die in critical care units and in hospices, identify factors associated with place of death and report 12-year trends in Scotland.MethodsWe undertook a cohort study of decedents aged ≥16 years in Scotland (2005–2017). Location of death was identified from linkage to the Scottish Intensive Care Society Audit Group database and National Records of Scotland Death Records. We developed a multinomial logistic regression model to identify factors independently associated with location of death.ResultsThere were 710 829 deaths in Scotland, of which 36 316 (5.1%) occurred in critical care units and 42 988 (6.1%) in hospices. As a proportion of acute hospital deaths, critical care deaths increased from 8.0% to 11.2%. Approximately one in eight deaths in those aged under 40 years occurred in critical care. Factors independently associated with hospice death included living in less deprived areas, cancer as the cause of death and presence of comorbidities. In contrast, liver disease and accidents as the cause of death and absence of comorbidities were associated with death in critical care.ConclusionsSimilar proportions of deaths in Scotland occur in critical care units and hospices. Given the younger age profile and unexpected nature of deaths occurring in critical care units, there is a need for a specific focus on end-of-life and bereavement support services in critical care units.

scholarly journals Prospective association between adherence to the Mediterranean diet and hepatic steatosis: the Swiss CoLaus cohort study

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e040959
Author(s):  
Saman Khalatbari-Soltani ◽  
Pedro Marques-Vidal ◽  
Fumiaki Imamura ◽  
Nita G. Forouhi
Keyword(s):  
Cohort Study ◽  
Fatty Liver ◽  
Hepatic Steatosis ◽  
Mediterranean Diet ◽  
Population Level ◽  
Inverse Association ◽  
Alcoholic Fatty Liver ◽  
The Mediterranean ◽  
Prospective Association

ObjectiveThe Mediterranean diet has been promoted as a healthy dietary pattern, but whether the Mediterranean diet may help to prevent hepatic steatosis is not clear. This study aimed to evaluate the prospective association between adherence to the Mediterranean diet and risk of hepatic steatosis.DesignPopulation-based prospective cohort study.SettingThe Swiss CoLaus Study.ParticipantsWe evaluated 2288 adults (65.4% women, aged 55.8±10.0 years) without hepatic steatosis at first follow-up in 2009–2012. Adherence to the Mediterranean diet was scaled as the Mediterranean diet score (MDS) based on the Mediterranean diet pyramid ascertained with responses to Food Frequency Questionnaires.Outcome measuresNew onset of hepatic steatosis was ascertained by two indices separately: the Fatty Liver Index (FLI, ≥60 points) and the non-alcoholic fatty liver disease (NAFLD) score (≥−0.640 points). Prospective associations between adherence to the Mediterranean diet and risk of hepatic steatosis were quantified using Poisson regression.ResultsDuring a mean 5.3 years of follow-up, hepatic steatosis was ascertained in 153 (6.7%) participants by FLI criteria and in 208 (9.1%) by NAFLD score. After multivariable adjustment, higher adherence to MDS was associated with lower risk of hepatic steatosis based on FLI: risk ratio 0.84 (95% CI 0.73 to 0.96) per 1 SD of MDS; 0.85 (0.73 to 0.99) adjusted for BMI; and 0.85 (0.71 to 1.02) adjusted for both BMI and waist circumference. When using NAFLD score, no significant association was found between MDS and risk of hepatic steatosis (0.95 (0.83 to 1.09)).ConclusionA potential role of the Mediterranean diet in the prevention of hepatic steatosis is suggested by the inverse association observed between adherence to the Mediterranean diet and incidence of hepatic steatosis based on the FLI. The inconsistency of this association when hepatic steatosis was assessed by NAFLD score points to the need for accurate population-level assessment of fatty liver and its physiological markers.

scholarly journals The SCottish Alcoholic Liver disease Evaluation: A Population-Level Matched Cohort Study of Hospital-Based Costs, 1991-2011

PLoS ONE ◽  
2016 ◽  
Vol 11 (10) ◽  
pp. e0162980 ◽  
Author(s):  
Janet Bouttell ◽  
James Lewsey ◽  
Claudia Geue ◽  
Grace Antony ◽  
Andrew Briggs ◽  
...  
Keyword(s):  
Cohort Study ◽  
Liver Disease ◽  
Alcoholic Liver Disease ◽  
Population Level ◽  
Matched Cohort ◽  
Matched Cohort Study

Mapping end-of-life and anticipatory medications in palliative care patients using a longitudinal general practice database

2021 ◽  
pp. 1-7
Author(s):  
H. Khalil ◽  
M. Garett ◽  
A. Byrne ◽  
P. Poon ◽  
K. Gardner ◽  
...  
Keyword(s):  
Health Care ◽  
Palliative Care ◽  
General Practice ◽  
End Of Life ◽  
Nurse Practitioners ◽  
Hospital Admissions ◽  
Population Level ◽  
Screening Tools ◽  
Care Needs ◽  
Stakeholder Consultation

Abstract Objective End-of-life and anticipatory medications (AMs) have been widely used in various health care settings for people approaching end-of-life. Lack of access to medications at times of need may result in unnecessary hospital admissions and increased patient and family distress in managing palliative care at home. The study aimed to map the use of end-of-life and AM in a cohort of palliative care patients through the use of the Population Level Analysis and Reporting Data Space and to discuss the results through stakeholder consultation of the relevant organizations. Methods A retrospective observational cohort study of 799 palliative care patients in 25 Australian general practice health records with a palliative care referral was undertaken over a period of 10 years. This was followed by stakeholders’ consultation with palliative care nurse practitioners and general practitioners who have palliative care patients. Results End-of-life and AM prescribing have been increasing over the recent years. Only a small percentage (13.5%) of palliative care patients received medications through general practice. Stakeholders’ consultation on AM prescribing showed that there is confusion about identifying patients needing medications for end-of-life and mixed knowledge about palliative care referral pathways. Significance of results Improved knowledge and information around referral pathways enabling access to palliative care services for general practice patients and their caregivers are needed. Similarly, the increased utility of screening tools to identify patients with palliative care needs may be useful for health care practitioners to ensure timely care is provided.

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